Ischial Apophysiolysis (IAL) Report of a Case and Review of the Literature

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Abstract
Ischial apophysiolysis (IAL) is a rare traumatic lesion. It gives little disability and has come to be of diagnostic interest to orthopaedic surgeons only recently. In general, 19th century authors who described epiphysial separations did not suspect the occurrence of IAL. In an extensive study of epiphysial separations, published in 1834, Rognetta45 stated that the epiphysis of the ischial tuberosity could be detached only with great difficulty. Though including a thorough review of the literature, he did not describe any particular case. Nélaton37 in 1869, doubted that any epiphysis of the bones of the trunk could become separated. However, one of the cases mentioned by Malgaigne27 was probably the first case of IAL on record. In 1847, he collected from the literature 6 fractures of the ischium, of which Percy's case was apparently an IAL. The patient fell on the buttock from horseback. After the acute stage had subsided and the ischial tuberosity was examined, “the cartilaginous crust” which covered it appeared to have been detached from the underlying bone. (“Comme si la croûte cartilagineuse qui la revêt eût été décollée de l'os”).27 In 1898, Poland39 referred to Parker, who had noted a case of separation of the epiphysis of the tuber ischii associated with suppuration following a kick. He also stated that he had seen a similar case following direct violence. The first 2 cases reported in full were those of Berry2 in 1912 and Milch32 in 1926. However, it was not until recently that this condition was considered to be a definite clinical and roentgenographic entity.33, 34, 35 The following case is interesting, since it occurred in a patient who was able to describe her trauma accurately. The injury was unusually severe and was rarely described as such in the literature.

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